son, who was a pupil of mine during the last winter. To understand its applicability, however, let me premise one or two words. Some months ago, I published an extensive and carefully collected series of statistical returns from various British hospitals, showing the operations of surgery were much less fatal in their results when patients were operated on under the condition of anæsthesia, and consequently, without any attendant suffering, than when, as formerly, they were submitted to all the horrors and agonies of the surgeon's knife in their usual waking and sensitive state. Thus, I found that, while, before the introduction of anesthesia, in every 100 cases of amputation of the thigh performed in our hospitals, from 40 to 45 of the patients died; the same amputation, when performed upon anesthetized patients, did not prove fatal to more than 25 in the 100 cases; or in other words, out of every 100 such operations, the previous induction of anesthesia was the means of preserving 15 or 20 human lives. So much are all our surgeons here impressed with the fact that the state of anesthesia saves their patients alike from pain, and from the subsequent hazards and dangers of pain, that I believe not one among them would deem himself justified in submitting a fellow-being to the tortures of the operating table, without the previous employment of chloroform. And, I believe, you are aware that we also use it here, in Edinburgh, constantly in midwifery-its omission being the exception, and a rare exception, to the general rule of its employment. By thus shielding our patients against the more severe portion of the pains of parturition, we not only save them from much immediate suffering, but we save their constitutions also from the effects and consequences of that suffering; and, as a general rule, they assuredly make both more rapid and more perfect recoveries. I most sincerely believe, that in thus cancelling the pains of labor, we also, to a great extent, cancel the perils of it; for all our highest authorities in pathology, admit that pain, when either great in excess, or great in duration, is in itself, and by itself, deleterious and destructive: and the mortality accompanying parturition is regulated principally by the law of the length and degree of the patient's struggles and sufferings. In the Dublin Lying-in Hospital, when under Dr. Collins' able care, out of all the women, 7050 in number, who were delivered within two hours from the commencement of labor, 22 died; or one in every 320. In 452 of his cases, the labor was prolonged above twenty hours, and out of these 452 mothers, 42 died; or one in every 11; a difference enormous in amount, and one strongly calculated to force us all to think seriously and dispassionately of the effects of severe suffering upon the maternal constitu Now the writer of the letter to which I have alluded, is the author of one of the most eloquent essays in the English language, on the holy character and genuineness of the Bible. He is not a physician, though deeply read in medical, as in all other forms of knowledge; and, aware of the dangers and destructive properties of severe pain, when unmitigated and unrestrained, he reasons thus: "If pain, when carried-as in parturition-to the stage which we call agony, or intense struggle amongst the vital functions, brings with it some danger to life, as I presume no one can deny must be the case, then it will follow, that, knowingly to reject a means of mitigating, or wholly cancelling the attendant suffering and its dangers (now that such a means has been discovered), travels, in my opinion on the road to suicide. If I am right in believing that danger to life lies in this direction, then, clearly, the act of rejecting the remedy against it, being wilful, lies in a suicidal direction. It is even worse than an ordinary movement in that direction, because it affects to make God an accomplice through the Scriptures in this suicidal movement, nay, the primal instigator to it, by means of a supposed curse interdicting the use of any means whatever, though revealed by Himself, for annulling that curse." The same argument which is here brought against the wilful rejection of anæsthetic measures by the patient, necessarily applies with the same spirit, but with some changes in the terms, against the wilful rejection of the same means by the medical attendant. But I must be done; for I fear I have exhausted your patience as well as my own time. Let me merely add, that I am sure you deeply regret and grieve with me that the interests of genuine religion should ever and anon be endangered and damaged by weak but well-meaning men believing and urging that this or that new improvement in medical knowledge, or in general science, is against the words or spirit of Scripture. We may always rest fully and perfectly assured that whatever is true in point of fact, or humane and merciful in point of practice, will find no condemnation in the Word of God. With many apologies for the unexpected length to which these remarks have extended, believe me, my dear sir, very faithfully J. Y. SIMPSON. yours, CHAPTER V. ON THE EARLY HISTORY AND PROGRESS OF ANESTHETIC MIDWIFERY.' "I do think you might spare her, And neither heaven nor man grieve at the mercy." MEASURE FOR MEASURE. In a communication laid before the Edinburgh Medico-Chirurgical Society in November last, I attempted to prove that the idea of cancelling and abrogating the pains inflicted by the knife of the surgeon had not entirely originated in our own times. I showed that Dioscorides, Pliny, Apuleius, Theodoric, Paré, and others,2 had long ago described, and some of them apparently practised, the induction of anesthesia, previous to operations, both by giving their patients narcotic substances to swallow and narcotic vapors to inhale. While making the researches upon which the communication alluded to was founded, I further attempted to ascertain if any writer had proposed to assuage or annul, by the same or by other means, the pains attendant upon human parturition. I failed, however, in finding any traces whatever, either of any practical attempts to abrogate or modify, by true anesthetic means, the pains of labor, or of any theoretical suggestions even as to the very possibility of effecting that desirable result. And I believe the history of the induction of anesthesia in midwifery does not date far back, like the history of anesthesia in surgery. The first instance in which the practice was adopted, occurred in my own practice in Edinburgh on the 19th January, 1847. The case was one of deformed pelvis, in which I had predetermined to extract the child by turning, and to try the inhalation of ether vapor upon the mother, with a view to facilitate that operation. During a week or two previously, I had anxiously waited for the supervention of labor in this patient; for, by the result, I expected that much would be decided in regard to the effect of ether-inhalation in parturition. Would it merely avert and abrogate the sufferings of the mother, without interfering with the uterine contractions? Or, would it arrest simultaneously both the contractions of the uterus and the sufferings that arise from them? As far as the proposed mode of delivery by turning was concerned, it was a matter of no vital importance whether the etherization stopped the uterine contractions or not. And, on this cir cumstance depended the eligibility of the case for a first trial of 1 From Edinburgh Monthly Journal of Medical Science, October, 1848, p. 209. ether-inhalation. The result was most satisfactory and most important; for it at once afforded me evidence of the one great fact upon which the whole practice of anesthesia in midwifery is founded-it proved, namely, that though the physical sufferings of the parturient patient could be annulled by the employment of ether-inhalation, yet the muscular contractions of the uterus were not necessarily interfered with; or, in other words, that the labor might go on in its course, although the sensations of pain usually attendant upon it were, for the time being, altogether abrogated. This case, with its more obvious results and inferences, was communicated to the Obstetric Society at their meeting on the 20th of January.' In the course of the subsequent three weeks I had an opportunity of trying anesthesia in several cases of natural labor and in one forceps case; and at the next meeting of the Obstetric Society, on the 10th February, I took an opportunity of bringing the subject under the attention of the members at greater length. In the published reports of the Society,' the various inferences which then appeared to me to be deducible in regard to it are given in the following terms: 1. That the state of anæsthesia procured for the patient a more or less perfect immunity from the conscious pain and suffering attendant upon labor. 2. That it did not, however, diminish the strength or regularity of the contractions of the uterus. 3. That, on the other hand, it apparently (more especially when combined with ergot) sometimes increased them in severity and number. 4. That the contraction of the uterus after delivery seemed perfect and healthy when it. was administered. 5. That the reflex assistant contractions of the abdominal muscles, &c., were apparently more easily called into action by artificial irritation, and pressure on the vagina, &c., when the patient was in an anæsthetic state. 6. That its employment might not only save the mother from more pain in the last stage of labor, but might probably save her also, in some degree, from the occurrence and consequences of the nervous shock attendant upon delivery, and thereby reduce the danger and fatality of childbed; and, 7. Its exhibition did not seem to be injurious to the child. Full details of some of the principal cases upon which these inferences were founded, were, along with other additional instances, subsequently thrown together and published in the form of a communication to the Monthly Journal of Medical Science. In that paper I made some observations on the question, Whether it would be proper to employ anæsthesia in natural labor? I adduced various reasons from physiology and pathology for believing that the parturient action of the uterus would go on healthily and uninterruptedly 'Monthly Journal, vol. 1846-47, p. 639. 2 Ibid. p. 795. "Notes on the Employment of the Inhalation of Sulphuric Ether in the Practice of Midwifery."-Monthly Journal of Medical Science for March, 1847, p. 721. though the influence of the mind and purely cerebral functions were suspended, and that the dangers of the nervous shock attendant upon labor would be lessened; and I pointed out the necessity of ascertaining, by a cautious series of observations, what counterindications there might be to the employment of the practice ;— whether it was ever apt to give a tendency to hemorrhage or other complications; its influence, if any, upon the child; the length of time its use might be continued in any one case, &c. At the date at which the paper that I have just referred to was written, viz., the 18th February, the longest time during which I had ventured to keep a parturient patient in the anesthetic state was about half an hour. And many who believed that this state might be induced without danger for a few minutes, entirely doubted whether it could be sustained for any great length of time without extreme hazard. During the experience, however, of the next two or three weeks, I ascertained the fact, that the anesthetic action could be safely kept up during labor for one, two, three, or more hours. At one of the subsequent meetings of the Obstetric Society this result and others were adduced, and the following additional deductions drawn, as stated in the words of the printed proceedings of the Society, viz., that,— 1. The state of anesthesia had little or no influence upon the fœtus, none, at least, of a deleterious kind-the fœtal heart increasing only a few beats, if at all, when the mother was kept long and fully anæsthetized, either during pregnancy or labor. 2. The mother, during labor, may be kept anæsthetized, if required, for one, two, three, or more hours. Dr. Simpson described two cases, in one of which the mother was about six, and in the other, about four hours anesthetized before the children were born. In both cases the duration of the intervals and of the pains before and during anæsthesia was noted (as in the experiments which Dr. Simpson had published on galvanism), and the anaesthesia seemed to have no effect either on their frequency or strength. But, 3. In two or three cases, Dr. Simpson had seen a very deep state of anesthesia modify apparently the full strength of uterine contractions, but they recurred immediately in full force, when the patient was allowed to fall back into a state of slighter anæsthesia. 4. Dr. Simpson had hitherto seen no traceable injury to either mother or child from its employment, but the reverse. 5. The inhaler he used was either a concave sponge saturated interiorly with ether and held over the face, or a simple portable flask without valves. The first case of labor in which I employed artificial anesthesia occurred, as I have already stated, on the 19th January, 1847. This case and its results were stated publicly, on the following day, to my class in the University, and immediately became extensively known to the profession through the medium of the public journals. In the course of a short time the practice of anesthesia began to 'Monthly Journal of Medical Science, 1847-48, p. 214. 2 See Medical Gazette for 1847, vol. xxxix. p. 460. Also Provincial Journal for 1847, |